Developing artificial intelligence (AI) tools for healthcare is a collaborative effort, bringing data scientists, clinicians, patients and other disciplines together. In this paper, we explore the collaborative data practices of research consortia tasked with applying AI tools to understand and manage multiple long-term conditions in the UK. Through an inductive thematic analysis of 13 semi-structured interviews with participants of these consortia, we aimed to understand how collaboration happens based on the tools used, communication processes and settings, as well as the conditions and obstacles for collaborative work. Our findings reveal the adaptation of tools that are used for sharing knowledge and the tailoring of information based on the audience, particularly those from a clinical or patient perspective. Limitations on the ability to do this were also found to be imposed by the use of electronic healthcare records and access to datasets. We identified meetings as the key setting for facilitating exchanges between disciplines and allowing for the blending and creation of knowledge. Finally, we bring to light the conditions needed to facilitate collaboration and discuss how some of the challenges may be navigated in future work.
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The growing integration of large language models (LLMs) into social operations amplifies their impact on decisions in crucial areas such as economics, law, education, and healthcare, raising public concerns about these models' discrimination-related safety and reliability. However, prior discrimination measuring frameworks solely assess the average discriminatory behavior of LLMs, often proving inadequate due to the overlook of an additional discrimination-leading factor, i.e., the LLMs' prediction variation across diverse contexts. In this work, we present the Prejudice-Caprice Framework (PCF) that comprehensively measures discrimination in LLMs by considering both their consistently biased preference and preference variation across diverse contexts. Specifically, we mathematically dissect the aggregated contextualized discrimination risk of LLMs into prejudice risk, originating from LLMs' persistent prejudice, and caprice risk, stemming from their generation inconsistency. In addition, we utilize a data-mining approach to gather preference-detecting probes from sentence skeletons, devoid of attribute indications, to approximate LLMs' applied contexts. While initially intended for assessing discrimination in LLMs, our proposed PCF facilitates the comprehensive and flexible measurement of any inductive biases, including knowledge alongside prejudice, across various modality models. We apply our discrimination-measuring framework to 12 common LLMs, yielding intriguing findings: i) modern LLMs demonstrate significant pro-male stereotypes, ii) LLMs' exhibited discrimination correlates with several social and economic factors, iii) prejudice risk dominates the overall discrimination risk and follows a normal distribution, and iv) caprice risk contributes minimally to the overall risk but follows a fat-tailed distribution, suggesting that it is wild risk requiring enhanced surveillance.
Accurate prediction of future blood glucose (BG) levels can effectively improve BG management for people living with diabetes, thereby reducing complications and improving quality of life. The state of the art of BG prediction has been achieved by leveraging advanced deep learning methods to model multi-modal data, i.e., sensor data and self-reported event data, organised as multi-variate time series (MTS). However, these methods are mostly regarded as ``black boxes'' and not entirely trusted by clinicians and patients. In this paper, we propose interpretable graph attentive recurrent neural networks (GARNNs) to model MTS, explaining variable contributions via summarizing variable importance and generating feature maps by graph attention mechanisms instead of post-hoc analysis. We evaluate GARNNs on four datasets, representing diverse clinical scenarios. Upon comparison with twelve well-established baseline methods, GARNNs not only achieve the best prediction accuracy but also provide high-quality temporal interpretability, in particular for postprandial glucose levels as a result of corresponding meal intake and insulin injection. These findings underline the potential of GARNN as a robust tool for improving diabetes care, bridging the gap between deep learning technology and real-world healthcare solutions.
Endogeneity, i.e. the dependence of noise and covariates, is a common phenomenon in real data due to omitted variables, strategic behaviours, measurement errors etc. In contrast, the existing analyses of stochastic online linear regression with unbounded noise and linear bandits depend heavily on exogeneity, i.e. the independence of noise and covariates. Motivated by this gap, we study the over- and just-identified Instrumental Variable (IV) regression, specifically Two-Stage Least Squares, for stochastic online learning, and propose to use an online variant of Two-Stage Least Squares, namely O2SLS. We show that O2SLS achieves $\mathcal O(d_{x}d_{z}\log^2 T)$ identification and $\widetilde{\mathcal O}(\gamma \sqrt{d_{z} T})$ oracle regret after $T$ interactions, where $d_{x}$ and $d_{z}$ are the dimensions of covariates and IVs, and $\gamma$ is the bias due to endogeneity. For $\gamma=0$, i.e. under exogeneity, O2SLS exhibits $\mathcal O(d_{x}^2 \log^2 T)$ oracle regret, which is of the same order as that of the stochastic online ridge. Then, we leverage O2SLS as an oracle to design OFUL-IV, a stochastic linear bandit algorithm to tackle endogeneity. OFUL-IV yields $\widetilde{\mathcal O}(\sqrt{d_{x}d_{z}T})$ regret that matches the regret lower bound under exogeneity. For different datasets with endogeneity, we experimentally show efficiencies of O2SLS and OFUL-IV.
Predicting next visit diagnosis using Electronic Health Records (EHR) is an essential task in healthcare, critical for devising proactive future plans for both healthcare providers and patients. Nonetheless, many preceding studies have not sufficiently addressed the heterogeneous and hierarchical characteristics inherent in EHR data, inevitably leading to sub-optimal performance. To this end, we propose NECHO, a novel medical code-centric multimodal contrastive EHR learning framework with hierarchical regularisation. First, we integrate multifaceted information encompassing medical codes, demographics, and clinical notes using a tailored network design and a pair of bimodal contrastive losses, all of which pivot around a medical codes representation. We also regularise modality-specific encoders using a parental level information in medical ontology to learn hierarchical structure of EHR data. A series of experiments on MIMIC-III data demonstrates effectiveness of our approach.
Advances in large language models (LLMs) provide new opportunities in healthcare for improved patient care, clinical decision-making, and enhancement of physician and administrator workflows. However, the potential of these models importantly depends on their ability to generalize effectively across clinical environments and populations, a challenge often underestimated in early development. To better understand reasons for these challenges and inform mitigation approaches, we evaluated ClinicLLM, an LLM trained on [HOSPITAL]'s clinical notes, analyzing its performance on 30-day all-cause readmission prediction focusing on variability across hospitals and patient characteristics. We found poorer generalization particularly in hospitals with fewer samples, among patients with government and unspecified insurance, the elderly, and those with high comorbidities. To understand reasons for lack of generalization, we investigated sample sizes for fine-tuning, note content (number of words per note), patient characteristics (comorbidity level, age, insurance type, borough), and health system aspects (hospital, all-cause 30-day readmission, and mortality rates). We used descriptive statistics and supervised classification to identify features. We found that, along with sample size, patient age, number of comorbidities, and the number of words in notes are all important factors related to generalization. Finally, we compared local fine-tuning (hospital specific), instance-based augmented fine-tuning and cluster-based fine-tuning for improving generalization. Among these, local fine-tuning proved most effective, increasing AUC by 0.25% to 11.74% (most helpful in settings with limited data). Overall, this study provides new insights for enhancing the deployment of large language models in the societally important domain of healthcare, and improving their performance for broader populations.
Gaussian and discrete non-Gaussian spatial datasets are prevalent across many fields such as public health, ecology, geosciences, and social sciences. Bayesian spatial generalized linear mixed models (SGLMMs) are a flexible class of models designed for these data, but SGLMMs do not scale well, even to moderately large datasets. State-of-the-art scalable SGLMMs (i.e., basis representations or sparse covariance/precision matrices) require posterior sampling via Markov chain Monte Carlo (MCMC), which can be prohibitive for large datasets. While variational Bayes (VB) have been extended to SGLMMs, their focus has primarily been on smaller spatial datasets. In this study, we propose two computationally efficient VB approaches for modeling moderate-sized and massive (millions of locations) Gaussian and discrete non-Gaussian spatial data. Our scalable VB method embeds semi-parametric approximations for the latent spatial random processes and parallel computing offered by modern high-performance computing systems. Our approaches deliver nearly identical inferential and predictive performance compared to 'gold standard' methods but achieve computational speedups of up to 1000x. We demonstrate our approaches through a comparative numerical study as well as applications to two real-world datasets. Our proposed VB methodology enables practitioners to model millions of non-Gaussian spatial observations using a standard laptop within a short timeframe.
Intensive care unit (ICU) patients often develop new health-related problems in their long-term recovery. Health care professionals keeping a diary of a patient's stay is a proven strategy to tackle this but faces several adoption barriers, such as lack of time and difficulty in knowing what to write. Large language models (LLMs), with their ability to generate human-like text and adaptability, could solve these challenges. However, realizing this vision involves addressing several socio-technical and practical research challenges. This paper discusses these challenges and proposes future research directions to utilize the potential of LLMs in ICU diary writing, ultimately improving the long-term recovery outcomes for ICU patients.
The recent advancements in artificial intelligence (AI) combined with the extensive amount of data generated by today's clinical systems, has led to the development of imaging AI solutions across the whole value chain of medical imaging, including image reconstruction, medical image segmentation, image-based diagnosis and treatment planning. Notwithstanding the successes and future potential of AI in medical imaging, many stakeholders are concerned of the potential risks and ethical implications of imaging AI solutions, which are perceived as complex, opaque, and difficult to comprehend, utilise, and trust in critical clinical applications. Despite these concerns and risks, there are currently no concrete guidelines and best practices for guiding future AI developments in medical imaging towards increased trust, safety and adoption. To bridge this gap, this paper introduces a careful selection of guiding principles drawn from the accumulated experiences, consensus, and best practices from five large European projects on AI in Health Imaging. These guiding principles are named FUTURE-AI and its building blocks consist of (i) Fairness, (ii) Universality, (iii) Traceability, (iv) Usability, (v) Robustness and (vi) Explainability. In a step-by-step approach, these guidelines are further translated into a framework of concrete recommendations for specifying, developing, evaluating, and deploying technically, clinically and ethically trustworthy AI solutions into clinical practice.
Applying artificial intelligence techniques in medical imaging is one of the most promising areas in medicine. However, most of the recent success in this area highly relies on large amounts of carefully annotated data, whereas annotating medical images is a costly process. In this paper, we propose a novel method, called FocalMix, which, to the best of our knowledge, is the first to leverage recent advances in semi-supervised learning (SSL) for 3D medical image detection. We conducted extensive experiments on two widely used datasets for lung nodule detection, LUNA16 and NLST. Results show that our proposed SSL methods can achieve a substantial improvement of up to 17.3% over state-of-the-art supervised learning approaches with 400 unlabeled CT scans.
Small data challenges have emerged in many learning problems, since the success of deep neural networks often relies on the availability of a huge amount of labeled data that is expensive to collect. To address it, many efforts have been made on training complex models with small data in an unsupervised and semi-supervised fashion. In this paper, we will review the recent progresses on these two major categories of methods. A wide spectrum of small data models will be categorized in a big picture, where we will show how they interplay with each other to motivate explorations of new ideas. We will review the criteria of learning the transformation equivariant, disentangled, self-supervised and semi-supervised representations, which underpin the foundations of recent developments. Many instantiations of unsupervised and semi-supervised generative models have been developed on the basis of these criteria, greatly expanding the territory of existing autoencoders, generative adversarial nets (GANs) and other deep networks by exploring the distribution of unlabeled data for more powerful representations. While we focus on the unsupervised and semi-supervised methods, we will also provide a broader review of other emerging topics, from unsupervised and semi-supervised domain adaptation to the fundamental roles of transformation equivariance and invariance in training a wide spectrum of deep networks. It is impossible for us to write an exclusive encyclopedia to include all related works. Instead, we aim at exploring the main ideas, principles and methods in this area to reveal where we are heading on the journey towards addressing the small data challenges in this big data era.
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